Suicide

Suicide (from Latin sui caedere, to kill oneself) is the act of willfully ending one's own life. It can also refer to the individual who has committed or attempted the act. Suicide is not simply an illness nor a condition. Rather, it is a complex set of behaviors that exists on a continuum, from ideas to actions.

Suicide occurs for any number of reasons, often relating to depression, substance abuse, shame, avoiding pain, financial difficulties, or other undesirable situations.

Views on suicide have been influenced by cultural views on existential themes such as religion, honor, and the meaning of life. Most Western and Asian religions—the Abrahamic religions, Buddhism, Hinduism—consider suicide a dishonorable act; in the West it was regarded as a serious crime and offense against God due to religious belief in the sanctity of life. Japanese views on honor and religion led to seppuku being respected as a means to atone for mistakes or failure during the samurai era; Japanese suicides rates remain some of the developed world's highest. In the twentieth century suicide in the form of self-immolation has been used as a form of protest, and in the form of kamikaze and suicide attacks as a military or terrorist tactic.

Medically assisted suicide (euthanasia, or the right to die) is a controversial ethical issue involving people who are terminally ill, in extreme pain, and/or have minimal quality of life through illness. Self-sacrifice for others is not usually considered suicide, as the goal is not to kill oneself but to save another.

The predominant view of modern medicine is that suicide is a mental health concern, associated with psychological factors such as the difficulty of coping with depression, inescapable suffering or fear, or other mental disorders and pressures. Suicide is sometimes interpreted in this framework as a "cry for help" and attention, or to express despair and the wish to escape, rather than a genuine intent to die. In this view, the focus of mental health professionals is to prevent the person from succeeding in killing themselves, and then to provide support, in the form of psychotherapy and/or medication, to assist them in regaining the will and ability to live a meaningful life.

Terminology

Suicidal behavior

Some people engage in acts intended to bring death or acts unlikely to result in death but that indicate self-destructive or suicidal thoughts. These acts include overdosing, reckless driving, or excessive drinking. This is called suicidal behavior.

Suicidal ideation

A common medical term for thoughts about suicide, which may be as detailed as a formulated plan, without the suicidal act itself. Although most people who undergo suicidal ideation do not commit suicide, some go on to make suicide attempts or take their own lives.

The range of suicidal ideation varies greatly from fleeting to detailed planning, role playing and unsuccessful attempts, which may be deliberately constructed to fail or be discovered or may be fully intended to succeed but not actually do so.

Attempted suicide

Attempted suicide generally refers to an act that was intended to cause death but failed.

Parasuicide

Not all seemingly self-destructive behavior is suicidal behavior. Acts that may resemble suicidal behavior but are not intended to lead to death, such as deliberately injuring oneself, are known as parasuicide. Some people engage in this type of behavior as a way of soothing themselves. People who engage in self-injurious behavior, such as cutting, however, are at higher risk of suicide.

In some cases, people who engage in suicidal behavior or parasuicide kill themselves accidentally—they had not intended the act to progress to a lethal outcome. For instance, they make take an overdose and expect to be discovered in time to be rescued.

Completed suicide

Completed suicide means successful taking of one's own life. It is impossible to know absolutely why someone did this, or even if they intended to. In the case of an attempted suicide, the only way to understand one's friend or loved one's intent is to talk about it. That, of course, is not an option after completed suicide, although conversations before the act and notes left behind may provide clues. In fact, the existence of an explanatory "suicide note" is often taken as evidence that the act was one of intentional suicide, rather than accident or homicide.

Questions about the phenomenon

One, rather classic, definition of the situation leading to suicide reads: "Suicide is not chosen; it happens when pain exceeds resources for coping with pain."

That said, it is clear, nevertheless, that suicide is a far more enigmatic and disconcerting phenomenon. Because of others' inability to directly occupy the mental world of the suicidal, suicide appears to elude easy explanation.

Among the questions, we have been challenged for millenia, are: What makes a person's behavior suicidal? What motivates such behavior? Is suicide morally permissible, or even morally required in some extraordinary circumstances? Is suicidal behavior rational? How to try to minimize such a behavior? The following text presents some philosophical, behavioral, medical, and sociological notions about these questions.

In addition, there are cases resulting in death that are either not suicide in legal terms or in technical terms.

Technical obstacles

While it is tempting to say that suicide is any self-caused death, this account is vulnerable to obvious counterexamples. An individual who knows the health risks of smoking or of skydiving, but willfully engages in these behaviors and dies as a result, could be said to be causally responsible for her own death but not to have committed suicide.

Similarly, an individual who takes a drink of hydrochloric acid, believing it to be lemonade, and subsequently dies caused her own death but did not engage in suicidal behavior.

Legal obstacles

Sometimes, not only are there self-caused deaths that are not suicides, but there are behaviors that result in death and are arguably suicidal in which the agent is not the cause of her own death or is so only at one remove.

This can occur when an individual arranges the circumstances for her death. A terminally ill patient who requests that another person inject her with a lethal dose of tranquilizers has, intuitively, committed suicide. Though she is not immediately causally responsible for her death, she appears morally responsible for her death, since she initiates a sequence of events which she intended to culminate in her death, a sequence which cannot be explained without reference to her beliefs and desires. Such a case might also be an example of a voluntary euthanasia.

Likewise, those who commit "suicide by cop," where an armed crime is committed in order to provoke police into shooting its perpetrator, are responsible for their own deaths despite not being the causes of their deaths. In these kinds of cases, such agents would not die, or would not be at an elevated risk for death, were it not for their initiating such causal sequences. (See Brandt 1975, Tolhurst 1983, Frey 1981, but for a possible objection see Kupfer 1990).

Philosophy of suicide

Undoubtedly, the challenge of simply fathoming suicide accounts for the vast array of attitudes toward suicide found in the history of Western civilization: bafflement, dismissal, heroic glorification, sympathy, anger, moral or religious condemnation.

Suicide is now an object of multidisciplinary scientific study, with sociology, anthropology, psychology, and psychiatry each providing important insights into suicide. Particularly promising are the significant advances being made in our scientific understanding of the neurological basis of suicidal behavior (Stoff and Mann 1997) and the mental conditions associated with it.

Nonetheless, certain questions about suicide seem to fall at least partially outside the domain of science, and indeed, suicide has been a focus of philosophical examination in the West since at least the time of Plato.

Suicide has always aroused deep passions in humanity. Suicide is a threat whether religious, existential, political, or emotional. It has been represented as the ultimate irrationality and evil, pure selfishness, a dangerous precedent, madness, and pathology.

Conceptions of suicide clearly are framed within and affected by the cultures they are born out of. Yet suicide is not merely a matter of navigating cultural norms, or the product of emergent social structures (though of course these play a role). There is a normative element to the question, there is a philosophy and a deontology of suicide.

Nearly all the great philosophers had positions on suicide. Kant made suicide a special example in his moral philosophy, and was troubled by the challenges it posed. Plato laid out specific instances where suicide was or was not deviant. Spinoza regarded the will to self-preservation as fundamental and key to value, and likewise suicide as true irrationality and wrong.

Some philosophers have in fact killed themselves. The most famous philosopher suicide though was Seneca. Seneca had earlier argued for the reason as well as virtue of suicide, that is before Nero’s wrath descended upon him forcing him to take his own life. Yet Seneca turns the question on its head. Yet with clarity Seneca writes “Living is not the good, but living well."

The question of death then should be the question of life. Life is justified not by nature as Spinoza would have it, or reason as Kant would have it, but by the living.

The dirtiest death is preferable to the daintiest slavery (Seneca).

To make more sense of the philosophical view of suicide, we present three excerpts:

If the covenant which unites man to society be considered, it will be obvious that every contract is conditional, must be reciprocal; that is to say, supposes mutual advantages between the contracting parties. … The citizen cannot be bound to his country, to his associates, but by the bonds of happiness. … Are these bonds cut asunder? He is restored to liberty. Society, or those who represent it, do they use him with harshness, do they treat him with injustice, do they render his existence painful? Chagrin, remorse, melancholy, despair, have they disfigured to him the spectacle of the universe? In short, for whatever cause it may be, if he is not able to support his evils, let him quit a world which from thenceforth is for him only a frightful desert. (d'Holbach 1970, 136-137).

When a man's circumstances contain a preponderance of things in accordance with nature, it is appropriate for him to remain alive; when he possesses or sees in prospect a majority of the contrary things, it is appropriate for him to depart from life. ... Even for the foolish, who are also miserable, it is appropriate for them to remain alive if they possess a predominance of those things which we pronounce to be in accordance with nature. (Cicero, III, 60-61).

One may well ask why, aside from the demands of religion, it is more praiseworthy for a man grown old, who feels his powers decrease, to await his slow exhaustion and disintegration, rather than to put a term to his life with complete consciousness? … In this case, suicide is quite natural, obvious, and should by rights awaken respect for the triumph of reason. This it did in those times when the leading Greek philosophers and the doughtiest Roman patriots used to die by suicide. … Conversely, the compulsion to prolong life from day to day, anxiously consulting doctors and accepting the most painful, humiliating conditions, without the strength to come nearer the actual goal of one’s life: that is far less worthy of respect. Religions provide abundant excuses to escape the need to kill oneself: this is how they insinuate themselves into those who are in love with life. Nietzsche (1984, 60).

But I’m curious to see just how much a man can endure! And if I reach the limit of the endurable, well, then I can just open the door and leave. (Hesse, 1961, 11)

When Durkheim wrote his great treatise on suicide in 1911 (Durkheim, 1911) and identified anomic suicide, he emphasized that poverty and deprivation are less likely to cause self-murder than a debilitating dissatisfaction with what is. … A constant devaluing of the given in the present and a yearning for an ever more glowing future is a profoundly destabilizing force in individual lives. (Rakoff, 1998)

Lastly, largely thanks to the work of sociologists, such as Durkheim (1987) and Laplace, suicide was increasingly viewed as a social ill reflecting widespread alienation and other attitudinal byproducts of modernity. In many European nations, the rise in suicide rates was thought to signal a cultural decline. The next two causes are typical:

Curiosity (The need to know what comes after life.)

Boredom (The dissatisfaction with life has resulted in more calculated and planned suicides.)

In fact, in some cases, suicide may be honorable. Suicides that are clearly other-regarding, aiming at protecting the lives or well-being of others, or at political protest, may fall into this category (Kupfer 1990, 73-74). Examples of this might include the grenade-jumping soldier or the spy who takes his life in order not to be subjected to torture that will lead to his revealing vital military secrets.

To avoid shame or dishonor (Under the Bushido ideal, if a samurai failed to uphold his honor, he could regain it by performing seppuku.)

Suicide as a form of defiance and protest.

Heroic suicide, for the greater good of others, is often celebrated. For instance, Mahatma Gandhi went on a hunger strike to prevent fighting between Hindus and Muslims, and, although he was stopped before dying, it appeared he would have willingly succumbed to starvation. This attracted attention to Gandhi's cause, and generated a great deal of respect for him as a spiritual leader.

Risk factors of suicide

Regardless of what specifically motivates someone to attempt suicide or complete suicide, a number of medical, biological, psychological and social risk factors are often involved. Those factors can vary based on age, gender, and ethnic group, and they can change over time. Some factors consistently increase a person's risk of suicide and attempted suicide. The factors that put people at higher risk include:

Prior suicide attempt(s).

Having a psychiatric disorder, such as depression, bipolar disorder, schizophrenia, or personality disorders.

Medical views of suicide

Modern medicine treats suicide as a mental health issue. Treatment, often including medication and psychotherapy, is directed at the underlying causes of suicidal thinking.

Clinical depression is the most common treatable cause, with alcohol or drug abuse being the next major categories. Other psychiatric disorders associated with suicidal thinking include bipolar disorder, schizophrenia, Borderline personality disorder, Gender identity disorder, and eating disorders.

Suicidal thoughts provoked by crises will generally settle with time and counseling. Severe depression can continue throughout life even with treatment and repetitive suicide attempts or suicidal ideation can be the result.

Overwhelmingly, suicidal thoughts are considered a medical emergency. Medical professionals advise that people who have expressed plans to kill themselves be encouraged to seek medical attention immediately. This is especially important if the means (weapons, drugs, or other methods) are available, or if the patient has crafted a detailed plan for executing the suicide.

Special consideration is given to trained personnel to look for suicidal signs in patients. Depressive people are considered a high-risk group for suicidal behavior. Suicide hotlines are widely available for people seeking help.

However, the negative and often too clinical reception that many suicidal people receive after relating their feelings to health professionals (threats of institutionalization, simply increasing dosages of medication, the stigmatization of suicide as a topic of discussion, and so forth) often causes them to keep their suicidal thoughts to themselves.

Potential warning signs of suicide

There are several possible indications that a friend or loved one is thinking about suicide. Here are some typical warning signs:

Talking about suicide, including making such statements as "I'm going to kill myself," "I wish I were dead," or "I wish I hadn't been born."

Withdrawing from social contact and having an increased desire to be left alone.

Wide mood swings, such as being emotionally high one day but deeply discouraged the next.

Preoccupation with death and dying or violence.

Changes in routine, including eating or sleeping patterns.

Personality changes, such as becoming very outgoing after being shy.

Risky or self-destructive behavior, such as drug use or unsafe driving.

Giving away belongings or getting affairs in order.

Saying goodbye to people as if they will not be seen again.

Religious views of suicide

Buddhism

For Buddhists, since the first precept is to refrain from the destruction of life, including oneself, suicide should be clearly considered a negative form of action. Despite this view, an ancient Asian ideology similar to seppuku called (hara-kiri) continues to influence oppressed Buddhists to choose the act of honor suicide.

Many questions arise from the ambiguity in defining suicide. From a Buddhist perspective these include questions such as whether nirvana is a kind of suicide. Thus, suicide is justified in the persons of the Noble Ones who have already cut off desire and by so doing neutralized their actions by making them incapable of producing further fruit. From the point of view of early Buddhism, suicide is a normal matter in the case of the Noble Ones who, having completed their work, sever their last link with the world and voluntarily pass into Nirvana, thus definitively escaping from the world of rebirths (Lamotte, 1965:106f).The significant distinction then, is that the Arhat (Noble One) acts without desire whereas the unenlightened person does not.

Judaism

Judaism has traditionally, in light of its great emphasis on the sanctity of life, viewed suicide as one of the most serious of sins. Suicide has always been forbidden by Jewish law in all cases. It is not seen as an acceptable alternative even if one is being forced to commit certain cardinal sins for which one must give up one's life rather than sin. The views on suicide have shifted lately, however.

In the past, the bodies of Jewish people who committed suicide traditionally were buried on the outskirts of a Jewish cemetery, but that is no longer necessarily the case either. Raymond Perlman of Sinai Mortuary in Phoenix says that suicide deaths today usually are dealt with the same as others. "To put (those bodies) in a corner or on the side is really additional punishment for the survivors." Perlman says, "So we would just classify (the suicide) as another death. Unfortunately, a suicide death in most cases punishes the living."

Jewish teachings suggest that those who commit suicide would not face God's punishment, Sherwin says. "Our teachings tell us that when we are in pain, God cries with us," Sherwin says, "If God doesn't judge and condemn, then how can we?"

Christianity

Early Christianity emerged at a time of heavy Roman persecution. Beginning with the death of Steven, there was an attraction to death as martyrdom and there was an understanding that death at the hands of evil could benefit the cause of salvation. Even the death of Jesus can be interpreted as a kind of suicide, (self-sacrifice) by some, such as Tertullian.

Of the seven or so suicides reported in Scripture, most familiar are Saul, Samson, and Judas. Saul apparently committed suicide to avoid dishonor and suffering at the hands of the Philistines. He is rewarded by the Israelites with a war hero's burial, there being no apparent disapproval of his suicide (1 Samuel 31:1-6). And while there is no hero's burial for Judas Iscariot (Matthew 27:5-7), Scripture is once more silent on the morality of this suicide of remorse.

The suicide of Samson has posed a greater problem for Christian theologians. Both Saint Augustine and Saint Thomas Aquinas wrestled with the case and concluded that Samson's suicide was justified as an act of obedience to a direct command of God.

Objections to suicide have a long history in the church. But the idea that suicide is an unforgivable sin is less easily traced. Among the Church Fathers, Saint Augustine was the most prominent and influential opponent of suicide.

Modern Catholicism

Suicide is always as morally objectionable as murder, and the Catholic Church has always rejected it as an evil choice.

Even though a certain psychological, cultural and social conditioning may induce a person to carry out an action which so radically contradicts the innate inclination to life, thus lessening or removing subjective responsibility, suicide, when viewed objectively, is a gravely immoral act. … In fact, it involves the rejection of love of self and the renunciation of the obligation of justice and charity towards one's neighbor, towards the communities to which one belongs, and towards society as a whole. In its deepest reality, suicide represents a rejection of God's absolute sovereignty over life and death, as proclaimed in the prayer of the ancient sage of Israel: 'You have power over life and death; you lead men down to the gates of Hades and back again' (Wis 16:13; cf. Tob 13:2) (John Paul II, 1995).

Anglicans

The 1996 Statement by the House of Bishops of the Anglican Church in America says:

(1) The Episcopal Diocese of Newark has entered a growing national debate by proposing quite irresponsibly. … (2) That self-killing (suicide) is a "moral choice" for the terminally ill, and for those living in persistent and/or progressive pain (i.e., with severely reduced "quality of life"); … (3) because "nowhere in the Bible does it say that there is a value to suffering simply for the sake of suffering; … and that therefore we need to "redefine" what we mean by "life" (assumedly to provide a rationale for destroying what now should be held to have no value).

Islam

Islam, like other Abrahamic religions, views suicide as sinful and highly detrimental to one's spiritual journey. For those who formerly believed, but ultimately rejected belief in God, the result seems unambiguously negative. A verse in the fourth chapter of the Qur'an, An-Nisaa (The Women) instructs; "And do not kill yourselves, surely Allah is most Merciful to you." (4:29)

The prohibition of suicide has also been recorded in authentic statements of Hadith. For example; "He who commits suicide by throttling shall keep on throttling himself in the Hell-fire, and he who commits suicide by stabbing himself, he shall keep stabbing himself in the Hell-fire."

Suicidal accommodation in Islam

In his 1996 Fatwa declaring war on the United States, Osama bin Laden quoted a Hadith passage that has the Prophet Mohammed describing heaven for the martyrs fallen in a holy war. The first moment blood gushes, they are guaranteed Islamic heaven. They receive crowns, jewels, and 72 dark-eyed houris or beautiful maidens, for each martyr. Similar Fatwa came later from Iranian Islamic leader Khomenei.

Hinduism

Suicide is in Hindu scripture called Pranatyaga ("Abandoning life force") and generally means intentionally ending one's own life through poisoning, drowning, burning, jumping, shooting, and the like.

Suicide has traditionally been condemned in Hindu scripture because, being an abrupt escape from life, it creates unseemly karma to face in the future. However, in cases of terminal disease or great disability, religious self-willed death through fasting - prayopavesa - is permitted. The person making such a decision declares it publicly, which allows for community regulation and distinguishes the act from suicide performed privately in traumatic emotional states of anguish and despair. Ancient lawgivers cite various stipulations: 1) inability to perform normal bodily purification; 2) death appears imminent or the condition is so bad that life's pleasures are nil; 3) the action must be done under community regulation (Subramuniyaswami, 1992)

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